PROJECT SUMMARY/ABSTRACT From the passage of the first US state sterilization law in Indiana in 1907 until the 1970s, approximately 60,000 people were sterilized based on eugenic criteria designed to limit the reproduction of the ?unfit?. A R21 grant enable our team to produce original empirical historical analyses of this practice with a dataset we created of over 20,000 sterilization approvals from California. Our interdisciplinary collaboration between historians and epidemiologists has generated methodological innovations and revealed important findings, including the disproportionate sterilization of Latina/o Californians, especially young Latinas, and the disparate implementation of consent processes across different demographic groups and different state hospitals. Our recently awarded R01 grant extends this research to North Carolina and Iowa, and formalizes methods to rigorously integrate quantitative epidemiologic approaches with qualitative, historical analysis. This supplement proposes the addition of eugenic sterilization data from Michigan from the period 1923 to 1963 to our dataset, which includes data from approximately 30,000 sterilizations from the states of California, North Carolina, and Iowa. This supplement would enable us to add data from approximately 3,800 sterilizations in state and county hospitals in Michigan. Ultimately our dataset would contain nearly 35,000 sterilization petitions, more than one half of all eugenic sterilizations reported in the United States in the 20th century. We will produce, harmonize and analyze de-identified eugenic sterilization datasets for each state, including, when available, data on the gender, age, ethnicity, nationality, diagnosis, institutional home, and family history of patients considered for sterilization in all four states. We will analyze eugenic sterilization datasets in conjunction with individual-level Census microdata, estimating and comparing population-based sterilization rates. We will apply the mixed methods approaches developed for our R01 research to four states, integrating quantitative findings with in-depth qualitative analysis of notes on patient forms to generate a richer understanding of the experiences of 35,000 people sterilized during the eugenics era. This study pertains to contemporary ethical, legal, and social issues in human genomics, and can provide new scholarly knowledge about the ways in which a particular variant of genetic determinism resulted in the widespread state-mandated deprivation of reproductive capacity. We will examine how eugenic stereotypes about race and ethnicity, gender, sexual behavior, and intellectual disability influenced four states? interventions into the lives of institutionalized and vulnerable persons. Our findings can serve as a backdrop for contemporary conversations about the extent to which conceptions of normality, disability, and genetic stigmatization can insinuate themselves into the norms of disease prevention and human improvement.